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  • 201.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Frykheden, Ola
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Erik
    Ljótsson, Brjánn
    Hedman, Erik
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    The Brunnsviken Brief Quality of Life Scale (BBQ): Development and Psychometric Evaluation2016Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, nr 3, s. 182-195Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Measurements of subjective quality of life (QoL) are an important complement to symptom ratings in clinical research and practice. Despite there being several established QoL self-rating scales, we identified a need for a freely accessible, easy-to-use inventory, validated for use with both clinical and non-clinical samples, based on the overall life satisfaction conceptualization of QoL. The Brunnsviken Brief Quality of life scale (BBQ) was designed to meet these requirements. Items were selected by performing a factor analysis on a large data-set of QoL ratings collected previously. Six life areas (Leisure time, View on life, Creativity, Learning, Friends and Friendship, and View of self) were identified as important for overall QoL and were included in the BBQ. A psychometric evaluation was performed using two independent samples: healthy undergraduate students (n = 163), and a sample seeking treatment for social anxiety disorder (n = 568). Results suggested a unifactorial structure, with good concurrent and convergent validity, high internal and test-retest reliability, and accurate classification ability. We conclude that the BBQ is a valid and reliable measure of subjective QoL for use in clinical and research settings. The BBQ is presently available in 31 languages and can be freely downloaded from www.bbqscale.com.

  • 202.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Stockholm Health Care Services, Sweden.
    Hamilton, William
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    How to Treat Depression With Low-Intensity Virtual Reality Interventions: Perspectives on Translating Cognitive Behavioral Techniques Into the Virtual Reality Modality and How to Make Anti-Depressive Use of Virtual Reality–Unique Experiences2019Inngår i: Frontiers in Psychiatry, ISSN 1664-0640, E-ISSN 1664-0640, Vol. 10, artikkel-id 792Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Depression is a common mental disorder with a large treatment gap. Low-intensity, automated virtual reality (VR) interventions (not requiring a therapist) is a scalable and promising solution now that VR is an accessible and mature, consumer technology. Yet unlike with phobias, there have been few attempts at translating evidence-based cognitive behavioral therapeutic (CBT) techniques for depression into the VR modality. In this paper, we discuss how specific CBT techniques can be made into VR experiences, including psychoeducation, behavioral activation, cognitive restructuring, and social skills training. We also discuss how VR-unique experiences, such as alternative embodiment and virtual pet interactions, can be made therapeutic. Creating a pre-clinical and clinical evidence base for these types of novel interventions should be considered a research priority, and high-quality development on par with other consumer VR applications will be essential to the success of any consumer-targeted intervention. If this is achieved, low-intensity VR interventions for depression have great potential to make an impact on public mental health.

  • 203.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Fagernäs, Simon
    Andersen, Joel
    Sigeman, Martin
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Therapist-led and at-home one-session Virtual Reality exposure therapy for public speaking anxiety using consumer hardware and software, with online maintenance: A randomized controlled trial2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: Exposure therapy is an effective treatment of public speaking anxiety (PSA), yet inherent logistic challenges prevent widespread dissemination. Previous research has revealed that Virtual Reality (VR) may be effectively used for realistic stimuli presentation, but past generations of VR hardware have been inaccessible and expensive. We reasoned that VR stimuli, delivered using modern consumer hardware and software, would enable one-session treatment of PSA, both in the form of traditional therapist-led treatment and as an internet intervention.

    Methods: N=50 adult participants from the general public with clinically significant PSA were recruited and randomized to either therapist-led one-session treatment followed by online maintenance promoting in-vivo exposure, or waiting-list. The three-hour exposure session included psychoeducation and had participants conducting speech exercises, framed as behavioral experiments targeting idiosyncratic catastrophic beliefs, in front of virtual audiences, and listening to audio recording afterwards. Primary outcome measure was selfreported PSA, assessed using a validated instrument, measured before and after the treatment session, weekly during the four-week maintenance period, and at the end. After the first phase of the study, the waiting-list group received a simple VR headset by post and were given access to an online version of the same treatment (including the maintenance program), conducted their own one-session treatment followed by the same maintenance program, and reported PSA using the same intervals as before. Data were analyzed using mixed effects modeling.

    Results: A significant time*group effect was found such that the treatment group reported a 6.92-point larger decrease in PSA symptoms per treatment step than the waiting-list, corresponding to a between-group d=0.84 after the one-session treatment, growing to d=1.56 after the maintenance period. Piece-wise modeling of the waiting-list group’s PSA scores before and after they received their at-home equivalent treatment revealed a 6.39-point difference in decrease (per step) after receiving treatment compared to before, corresponding to a within-group d=1.22 after the at-home one-session treatment, growing to d=1.78 after the maintenance period.

    Conclusions: This trial demonstrates that simple, consumer VR hardware and software can be used to treat PSA using a one-session format, with large effect sizes. To our knowledge, this is the first study to evaluate the potential of internet-administered, at-home VR treatment, the results of which are promising.

  • 204.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Fagernäs, Simon
    Andersen, Joel
    Sigeman, Martin
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Therapist-led and self-led one-session Virtual Reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Public speaking anxiety (PSA) is a common condition which can be treated effectively with exposure therapy. However, inherent difficulties in stimuli presentation and control limits dissemination and the therapeutic potential. Virtual Reality (VR) technology has the potential to resolve these issues and provide a scalable platform for self-help interventions. No previous study has examined whether this can be achieved using the first generation of consumer VR hardware and software. In the current trial, n=25+25 participants were randomized to either one-session VR exposure therapy for PSA followed by a four-week internet-administered VR to in-vivo transition program, or a waiting-list. Linear mixed effects modeling revealed significant, large (within Cohen’s d=1.67) decreases in self-reported PSA. The waiting-list was then given access to an internet-administered, self-led version of the same VR exposure therapy to be conducted at home, followed by the same transition program. Dual-slope mixed effects modeling revealed significant, large (d=1.35) decreases in self-reported PSA. Results were maintained or improved at the six-month follow-up. We show for the first time that low-cost, off-the-shelf consumer VR hardware and software can be used to conduct exposure therapy for PSA, both in the traditional, previously unpractical one-session format, and in a novel self-led, at-home format.

  • 205.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Fagernäs, Simon
    Andersen, Joel
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Sigeman, Martin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial2019Inngår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 61, s. 45-54Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Public speaking anxiety (PSA) is a common condition which can be treated effectively with exposure therapy. However, inherent difficulties in stimuli presentation and control limits dissemination and the therapeutic potential. Virtual Reality (VR) technology has the potential to resolve these issues and provide a scalable platform for self-help interventions. No previous study has examined whether this can be achieved using the first generation of consumer VR hardware and software. In the current trial, n = 25 + 25 participants were randomized to either one-session therapist-led VR exposure therapy for PSA followed by a four-week internet-administered VR to in-vivo transition program, or a waiting-list. Linear mixed effects modeling revealed significant, large (within Cohen’s d = 1.67) decreases in self-reported PSA. The waiting-list was then given access to an internet-administered, self-led version of the same VR exposure therapy to be conducted at home, followed by the same transition program. Dual-slope mixed effects modeling revealed significant, large (d = 1.35) decreases in self-reported PSA. Results were maintained or improved at six- and twelve-month follow-ups. We show for the first time that low-cost, off-the-shelf consumer VR hardware and software can be used to conduct exposure therapy for PSA, both in the traditional, previously impractical one-session format, and in a novel self-led, at-home format.

  • 206.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Hamilton, William
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    The Potential of Consumer-Targeted Virtual Reality Relaxation Applications: Descriptive Usage, Uptake and Application Performance Statistics for a First-Generation Application2019Inngår i: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, artikkel-id 132Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Virtual Reality (VR) technology can be used to create immersive environments that promote relaxation and distraction, yet it is only with the recent advent of consumer VR platforms that such applications have the potential for widespread dissemination, particularly in the form of consumer-targeted self-help applications available at regular digital marketplaces. If widely distributed and used as intended, such applications have the potential to make a much-needed impact on public mental health. In this study, we report real-world aggregated uptake, usage and application performance statistics from a first-generation consumer-targeted VR relaxation application which has been publicly available for almost 2 years. While a total of 40,000 unique users signals an impressive dissemination potential, average session duration was lower than expected, and the data suggests a low number of recurrent users. Usage of headphones and auxiliary input devices was relatively low, and some application performance issues were evident (e.g., lower than intended framerate and occurrence of overheating). These findings have important implications for the design of the future VR relaxation applications, revealing primarily that user engagement needs to be addressed in the early stage of development by including features that promote prolonged and recurrent use (e.g., gamification elements).

  • 207.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Hamilton, William
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Mimerse, Sweden.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Powers, Mark B.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Creating state of the art, next-generation Virtual Reality exposure therapies for anxiety disorders using consumer hardware platforms: Design considerations and future directions2017Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, nr 5, s. 404-420Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Decades of research and more than 20 randomized controlled trials show that Virtual Reality exposure therapy (VRET) is effective in reducing fear and anxiety. Unfortunately, few providers or patients have had access to the costly and technical equipment previously required. Recent technological advances in the form of consumer Virtual Reality (VR) systems (e.g. Oculus Rift and Samsung Gear), however, now make widespread use of VRET in clinical settings and as self-help applications possible. In this literature review, we detail the current state of VR technology and discuss important therapeutic considerations in designing self-help and clinician-led VRETs, such as platform choice, exposure progression design, inhibitory learning strategies, stimuli tailoring, gamification, virtual social learning and more. We illustrate how these therapeutic components can be incorporated and utilized in VRET applications, taking full advantage of the unique capabilities of virtual environments, and showcase some of these features by describing the development of a consumer-ready, gamified self-help VRET application for low-cost commercially available VR hardware. We also raise and discuss challenges in the planning, development, evaluation, and dissemination of VRET applications, including the need for more high-quality research. We conclude by discussing how new technology (e.g. eye-tracking) can be incorporated into future VRETs and how widespread use of VRET self-help applications will enable collection of naturalistic “Big Data” that promises to inform learning theory and behavioral therapy in general.

  • 208.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Predicting treatment outcomes after Virtual Reality exposure therapy using gaze proxy data collected during exposure: Preliminary findings2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    BACKGROUND: Virtual Reality exposure therapy (VRET) is an efficacious treatment of phobias and allows for automatic data collection during standardized yet naturalistic exposure paradigms, yet next to no research has explored the clinical potential of such data. GOALS: To explore the predictive potential of using gaze proxy data collected during VRET to predict treatment outcomes. METHODS: Gaze focus proxy data from n=29 participants undergoing gamified, self-help VRET for spider phobia were extracted, compiled, and modeled. The VRET session featured eight levels with increasingly frightening spiders, each with an approach task requiring participants to keep looking at the phobic object for a specified time. Relative spider gaze focus was defined as time spent looking at each spider at each level (derived from head movement and overlap) divided by total time in level. High- versus low-improvement was defined using median-split on subsequent improvements on an in-vivo behavioral approach task. RESULTS: During the final three levels of the exposure session, relative spider focus time was initially lower among high-improvers (p=.039) and the decrease was lower over levels than among the low-improvers (p=.029). This suggests that non-improvers experienced a fear level mismatch during the final exposure phase. There were no differences in gaze patterns during other phases of the session. CONCLUSIONS: These preliminary results suggest that gaze proxy data automatically collected during VRET, even when rudimentary, can be used to predict treatment outcomes, and may thus be used to automatically personalize the exposure design of VRET self-help applications during actual use, to increase efficacy.

  • 209.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    What is so frightening about spiders? Self‐rated and self‐disclosed impact of different characteristics and associations with phobia symptoms2019Inngår i: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 60, nr 1, s. 1-6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Spider phobia is a common and impairing mental disorder, yet little is known about what characteristics of spiders that spider phobic individuals find frightening. Using screening data from a clinical trial, we explored which characteristics that spider‐fearful individuals (n = 194) rated as having the greatest impact on fear, used factor analysis to group specific characteristics, and explored linear associations with self‐reported phobia symptoms. Second, a guided text‐mining approach was used to extract the most common words in free‐text responses to the question: “What is it about spiders that you find frightening?” Both analysis types suggested that movement‐related characteristics of spiders were the most important, followed by appearance characteristics. There were, however, no linear associations with degree of phobia symptoms. Our findings reveal the importance of targeting movement‐related fears in in‐vivo exposure therapy for spider phobia and using realistically animated spider stimuli in computer‐based experimental paradigms and clinical interventions such as Virtual Reality exposure therapy.

  • 210.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Zetterlund, Elin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Attitudes Toward and Familiarity With Virtual Reality Therapy Among Practicing Cognitive Behavior Therapists: A Cross-Sectional Survey Study in the Era of Consumer VR Platforms2019Inngår i: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, artikkel-id 176Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Virtual reality exposure therapy (VRET) is an efficacious treatment for fear and anxiety and has the potential to solve both logistic issues for therapists and be used for scalable self-help interventions. However, VRET has yet to see large-scale implementation in clinical settings or as a consumer product, and past research suggests that while therapists may acknowledge the many advantages of VRET, they view the technology as technically inaccessible and expensive. We reasoned that after the 2016 release of several consumer virtual reality (VR) platforms and associated public acquaintance with VR, therapists' concerns about VRET may have evolved. The present study surveyed attitudes toward and familiarity with VR and VRET among practicing cognitive behavior therapists (n = 185) attending a conference. Results showed that therapists had an overall positive attitude toward VRET (pros rated higher than cons) and viewed VR as applicable to conditions other than anxiety. Unlike in earlier research, high financial costs and technical difficulties were no longer top-rated negative aspects. Average negative attitude was a larger negative predictor of self-rated likelihood of future use than positive attitude was a positive predictor and partially mediated the positive association between VRET knowledge and likelihood of future use, suggesting that promotional efforts should focus on addressing concerns. We conclude that therapist's attitudes toward VRET appear to have evolved in recent years, and no longer appear to constitute a major barrier to implementing the next generation of VR technology in regular clinical practice.

  • 211.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Zetterlund, Elin
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Attitudes towards and familiarity with Virtual Reality therapy among practicing cognitive behavior therapists: A first survey study in the era of consumer VR platforms2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Objectives: To survey attitudes towards, knowledge of and familiarity with Virtual Reality (VR) technology and VR exposure therapy among practicing cognitive behavior therapists, after the recent release of consumer VR platforms, with the aim of identifying potential human barriers to implementing this technology and therapeutic method in regular care. Participants: 185 practicing cognitive behavior therapists attending a conference.Measures: Self-rated likelihood of future use of VR in a clinical setting, applicability of VR to treating specific mental disorders, as well as ratings of different positive and negative aspects of VR exposure therapy – all assessed using a standardized survey.Results: Very few respondents reported having used VR clinically. Therapists had an overall positive attitude toward VRET (pros rated higher than cons) and viewed VR as applicable to conditions other than anxiety. Unlike in earlier research, a high financial cost was no longer a top-rated negative aspects. Average negative attitude was a larger negative predictor of self-rated likelihood of future use than positive attitude was a positive predictor.Conclusions: We conclude that therapist’s attitudes towards VRET appear to have evolved in recent years, coinciding with the release of consumer VR platforms, and no longer appear to constitute a major barrier to implementing the next generation of VR technology in regular clinical practice.

  • 212.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Nordby, Kent
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Svartdal, Frode
    Domain-specific quality of life across five European countries: Cross-cultural validation of the Brunnsviken Brief Quality of life (BBQ) scale2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 590-590Konferansepaper (Fagfellevurdert)
    Abstract [en]

    The Brunnsviken Brief Quality of life (BBQ) scale is a valid, reliable and accessible self-report measure of subjective quality of life for use with both clinical and non-clinical populations. Although the BBQ has been professionally translated from original Swedish into over thirty languages, psychometric evaluations of other language versions are so far lacking. BBQ data was collected as part of an international study on procrastination in students and employees: n = 749 from Finland, n = 599 from Sweden, n = 542 from Norway, n = 411 from Germany, and n = 315 from Italy. Weighted satisfaction ratings (score range 0-16) for each of the BBQ’s six domains (Leisure, View on life, Creativity, Learning, Friends and friendships, and View on self), along with a total sum score and Cronbach’s alphas, were calculated and compared. Samples did not differ in BBQ total scores (F[4,2611] = 1.006, p = .403). Although there were some differences between samples on specific items, these were small (total difference M = 0.00, SD = 0.74) and confidence intervals overlapped, with the exception of the German sample that rated lower Learning than all other samples (p < .05, Bonferroni-adjusted). Cronbach’s alpha ranged from 0.752 (Finland) to 0.674 (Italy). Convergent validity (as assessed by correlations with scores on the Satisfaction With Life Scale) was high, ranging from r = .64 (Finland) to r = .42 (Italy). The BBQ is a valid measure of subjective quality of life in the examined languages. There are only minor cross-country differences in the quality of life domains measured by the BBQ.

  • 213.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Differential impact of performance and interaction related types of social anxiety symptoms on different quality of life domains2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 748-748Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Social anxiety disorder (SAD) is a common disorder associated with impaired quality of life (QoL), that indexes anxious distress and avoidance related to social situations. The DSM-5 features a specifier to delineate those with only performance-related social anxiety, yet little is known whether performance- and interaction-related anxieties have a differential impact on total QoL and on different QoL domains. To investigate this, we pooled screening data from eight intervention studies for SAD (n = 2017). Total sample mean age was 35.28 (SD = 12.26) and 69% were female. SAD symptoms were measured using the self-rated Liebowitz Social Anxiety Scale with items classified as measuring either performance or interaction anxiety. QoL, both total and across four domains, was measured using the Quality of Life Inventory. Data was analyzed using multiple regression models featuring the two anxiety scores as predictors, and by simulating the Performance-only specifier through 2˙2 median-split subgrouping and standard ANOVAs. Both interaction and performance anxieties were independently associated with lower QoL in general and across domains. Interaction anxiety had a larger negative impact on Personal Growth- and Achievement-related QoL than performance anxiety. The High-Performance/Low-Interaction-group rated higher Achievement-related QoL compared to the Low-Performance/High-Interaction-group (p = .012), yet groups were matched on total QoL and on other domains. Other group differences were in the expected direction.

    QoL impairments in SAD is primarily driven by number of feared social situations, and only secondarily by types of fear social situations, with interaction anxiety having a larger, negative impact on some QoL domains.

  • 214.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Silijehom, Ola
    Johansson, Magnus
    Forster, Martin
    Andreasson, Sven
    Hammberg, Anders
    Combining online community reinforcement and family training with a parent training program for parents with partners suffering from alcohol use disorder: Study protocol for a randomized controlled trial2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Introduction: Partners and children of individuals with alcohol use disorder (AUD) present impaired quality of life and mental health, yet seldom seek or participate in traditional supportive interventions. Engaging the parent/partner without AUD in treatment is a promising way of supporting behavior change in both the child and the parent with AUD. Universal parent training (PT) programs are effective in increasing children´s well-being and decreasing problem behaviors, but have yet to be tailored for children with a parent with AUD. Community reinforcement approach and family training (CRAFT) programs are conceptually similar, and aim to promote behavior change in individuals with AUD by having a concerned significant other change environmental contingencies. There has been no study on whether these two interventions can be combined and tailored for partners of individuals with AUD with common children, and delivered as accessible, online self-help. Methods and analysis: N=300 participant who share a child showing mental health problems with a person with AUD, but do not present AUD themselves, will be recruited from the general public and randomized 1:1 to either a four-module, online combined PT and CRAFT program, or a psychoeducation-only comparison intervention. Primary outcome will be the child’s mental health. Additional outcomes will cover the partner’s drinking, the participants own mental health and drinking, the child’s social adjustment, treatment-seeking in all three parties, and parental self-efficacy. Measures will be collected pre-, mid- and post-intervention, and three times during a two-year follow-up period. Data will be analyzed using mixed effects modeling. Trial status: This trial is currently recruiting.

  • 215.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Siljeholm, Ola
    Johansson, Magnus
    Forster, Martin
    Andreasson, Sven
    Hammarberg, Anders
    Combining online Community Reinforcement and Family Training (CRAFT) with a parent-training programme for parents with partners suffering from alcohol use disorder: study protocol for a randomised controlled trial2018Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 8, artikkel-id e020879Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Partners and children of individuals with alcohol use disorder (AUD) present with impaired quality of life and mental health, yet seldom seek or participate in traditional supportive interventions. Engaging the parent/partner without AUD in treatment is a promising way of supporting behavioural change in both the child and the parent with AUD. Universal parent-training (PT) programmes are effective in increasing children’s well-being and decreasing problem behaviours, but have yet to be tailored for children with a parent with AUD. Community Reinforcement Approach And Family Training (CRAFT) programmes are conceptually similar, and aim to promote behavioural change in individuals with AUD by having a concerned significant other change environmental contingencies. There has been no study on whether these two interventions can be combined and tailored for partners of individuals with AUD with common children, and delivered as accessible, online self-help.

    Methods and analysis: n=300 participants with a child showing mental health problems and partner (co-parent) with AUD, but who do not themselves present with AUD, will be recruited from the general public and randomised 1:1 to either a four-module, online combined PT and CRAFT programme or a psychoeducation-only comparison intervention. Primary outcome will be the child’s mental health. Additional outcomes will cover the partner’s drinking, the participants own mental health and drinking, the child’s social adjustment, treatment seeking in all three parties and parental self-efficacy. Measures will be collected preintervention, mid-intervention and postintervention, and three times during a 2-year follow-up period. Data will be analysed using mixed-effects modelling.

    Ethics and dissemination: This study has been approved by the Stockholm Regional Ethical Review Board (2016/2179-31). The results will be presented at conferences and published as peer-reviewed publications.

    Trial registration number: ISRCTN38702517; Pre-results.

  • 216.
    Ljunggren, Ingrid
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Samtalet som psykologisk metod2014Bok (Annet vitenskapelig)
    Abstract [sv]

    Samtalet som psykologisk metod presenterar konkreta beskrivningar och en systematisering av generiska professionella samtalsfärdigheter. De har ofta betecknats som s.k. tyst kunskap och som därför inte tidigare i nämnvärd utsträckning har systematiserats så att man kan beskriva vad och hur man gör när man leder ett professionellt samtal. Dessa generiska färdigheter är av sådan karaktär att de ligger till grund för alla professionella psykologuppdrag. Boken ger även förslag på hur undervisning och bedömning av samtalsfärdigheter kan läggas upp.

    Boken vänder sig i första hand till psykologstudenter men även till studenter vid övriga professionsutbildningar där samtalet är ett professionellt verktyg. Det kan till exempel vara socionomer, läkare och jurister. Förhoppningsvis kan även redan yrkesverksamma ha glädje av boken.

  • 217.
    Ljunggren, Ingrid
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Stödsamtal och stödterapi2017Bok (Annet vitenskapelig)
    Abstract [sv]

    Många olika yrkesgrupper använder stödjande samtal professionellt. Stödsamtal och stödterapi används inom till exempel sjukvård, social­­tjänst, skola och psykiatri när man av olika skäl inte kan erbjuda traditionell och evidensbaserad psykoterapi.Trots att dessa stödformer är så vanliga har de inte särskilt hög status och är inte heller väl utforskade. De bygger därmed till stor del på samtalsledarens egna erfarenheter och tysta kunskap om vad som är viktigt i stödjande samtal.


    Denna bok operationaliserar och konkretiserar begrepp som hjälper oss att förstå vad skickliga stödsamtalsledare och stödterapeuter gör, hur de gör det och varför. Därmed synliggörs professionella stödsamtal och stödterapi som det kvalificerade arbete det faktiskt är.


    I boken beskrivs den professionella samtalsledarens generiska samtals­färdigheter. Både stödsamtalet och stödterapin ges en teoretisk ram men presenteras också med konkreta exempel. Såväl det gemensamma som skillnaderna mellan de båda stödformerna tydliggörs.


    Stödsamtal och stödterapi riktar sig främst till professionella hjälpare inom psykiatri, vård, skola och omsorg samt till studenter inom dessa utbildningsområden. Den är en fristående fortsättning till Samtalet som psykologisk metod (2014).

  • 218.
    Lundgren, Tobias
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Parling, Thomas
    Swedish Acceptance and Action Questionnaire (SAAQ): A psychometric evaluation2017Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, nr 4, s. 315-326Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Psychological inflexibility and experiential avoidance are equivalent (with somewhat different connotations) concepts and refer to an unwillingness to remain in contact with particular private events. This concept is most often measured by the Acceptance and Action Questionnaire (AAQ-II) and is strongly related to psychopathology and behavioral effectiveness. In this study, the preliminary psychometric properties of the Swedish version of the AAQ-II (Swedish Acceptance and Action QuestionnaireSAAQ) are presented. The study is done in two steps. In the first step, the 10-item version of the AAQ-II is investigated through principal component analysis (n=147). Secondly, due to problems with the component structure, the instrument is reduced to a six-item version and its validity and internal consistency are investigated (n=154). The six-item version shows good concurrent and convergent validity as well as satisfying internal consistency (=.85). Furthermore, the Swedish six-item version of the AAQ-II showed one strong component. Test-retest reliability was satisfactory (r=.80; n=228). In future research, predictive and external validity would be important to investigate in order to further ensure that the SAAQ is a useful measure for clinical research. In conclusion, the SAAQ has satisfactory psychometric properties, but more data need to be gathered to further explore the possibilities for the instruments in Swedish contexts.

  • 219.
    Lundgren, Tobias
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Reinebo, Gustaf
    Löf, Per-Olov
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Näslund, Markus
    Svartvadet, Per
    Parling, Thomas
    The Values, Acceptance, and Mindfulness Scale for Ice Hockey: A Psychometric Evaluation2018Inngår i: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 9, artikkel-id 1794Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    There is an increased interest in mindfulness, acceptance, and values based skills training interventions in sports but there is a lack of psychometrically evaluated instruments to investigate the processes adapted to sport populations. This paper describes the development and investigation of an instrument that measure acceptance, mindfulness, and values for ice hockey players. Ice hockey players at elite and sub elite level (n = 94) in Sweden participated in the study. The results reveal that the values, acceptance, and mindfulness (VAMS) shows acceptable internal consistency (alpha = 0.76) and satisfactory validity. Furthermore, scores on the VAMS predicts ice hockey performance as measured by assists and team points. Future research is suggested to evaluate the sensitivity of the instrument for longitudinal research design studies. In conclusion, VAMS is a useful instrument for practitioners and researchers to increase the knowledge in how psychological processes such as acceptance, mindfulness, and values influence performance among ice hockey players.

  • 220. Lussier, Desiree
    et al.
    Hayes, Rita
    Horta, Marilyn
    Lin, Tian
    Frazier, Ian
    Weir, Devon
    Perez, Eliany
    Fischer, Håkan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Månsson, Kristoffer
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Feifel, David
    Ebner, Natalie
    Four-week Intranasal Oxytocin vs Placebo Administration Modulation of Amygdala and Accumbens Volume2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Introduction: Gray matter (GM) volumes of limbic and striatal structures, including the amygdala (AMY)1 and the nucleus accumbens (NAcc)2, are associated with socioemotional phenotypes. For instance, GM atrophy accompanies some dementias in which socioemotional processing is impaired2,3. Evidence suggests that intranasally administered oxytocin (OT) exerts a modulatory effect on socioemotional processing4, with the AMY5,6 and NAcc7 constituting strong potential targets for this in the brain modulatory process. There, further, is evidence that AMY volume is associated with endogenous OT levels in young adults8. However, the generalizability of this finding to older adults is currently unknown. Additionally, literature describing the effects of long-term OT administration on the aging brain is lacking.

    Methods: Twenty-four healthy male participants, aged 55 years and older, were randomly assigned in a double-blind design to self-administer intranasally either 24IUs of OT or placebo (P) twice daily for four weeks as part of an ongoing clinical trial conducted at the University of Florida. A structural T1-weighted magnetization prepared rapid gradient-echo (MPRAGE) (1 mm3 isotropic voxels) scan was acquired at baseline and again posttreatment using a 3T Phillips scanner with a 32-channel head coil. Freesurfer was used for whole-brain structural segmentation9. Subcortical segmentation statistics (aseg.stat) volumetrics were extracted and analyses were conducted with Rstudio. The Stats10 package for R was used to run paired t-tests within each of the two treatment conditions (OT vs. P) to determine volume changes in amygdala and nucleus accumbens pre- to post-treatment. All analyses were conducted blind to the experimental conditions. Unblinding will be undertaken prior to the presentation of the final results.

    Results: T-tests resulted in a significant increase in bilateral NAcc GM volume for one (t = -5.60, df = 12, p-value < 0.001 left; t = -4.2851, df = 12, p-value = 0.001 right) but not in the other (t = -1.58, df = 10, p-value = 0.149 left; t = t = -1.78, df = 10, p-value = 0.105 right) treatment condition. Additionally, there was a trend-wise decrease in total GM volume from pre- to post-treatment in the right AMY in one (t = 3.20, df = 12, p-value = 0.008) but not in the other (t = 0.89, df = 10, p-value = 0.396) treatment condition. However, this observation was reversed for the left AMY (t = 1.130, df = 12, p-value = 0.280 and t = 3.2065, df = 10, p-value = 0.009, respectively).

    Conclusions: The results of this project suggest that 4-week intranasal OT vs. P administration differentially modulates brain volume in AMY and NAcc in healthy older men, with these modulatory effects possibly lateralized for the AMY. These findings are in line with previous literature showing that there may be hemispheric differences in socioemotional task-related AMY activation. Future extensions of this work will include a larger sample size to confirm the robustness of the findings and investigation into associations with socioemotional functioning.

  • 221. Långh, Ulrika
    et al.
    Hammar, Martin
    Klintwall, Lars
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Bölte, Sven
    Allegiance and knowledge levels of professionals working with early intensive behavioural intervention in autism2017Inngår i: Early Intervention in Psychiatry, ISSN 1751-7885, E-ISSN 1751-7893, Vol. 11, nr 5, s. 444-450Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: Early intensive behavioural intervention (EIBI) for children with autism spectrum disorder (ASD) is often delivered using a community model. Behaviourmodification experts train and supervise non-experts (e.g. preschool personnel) to teach children according to applied behaviour analysis principles in their natural environment. Several factors predict EIBI outcomes in ASD, for example, knowledge of EIBI and EIBI allegiance among trainers. The aim of the present study was to survey levels of knowledge about and allegiance towards EIBI.

    Methods: Formal knowledge of EIBI and EIBI allegiance was surveyed in supervised preschool staff conducting EIBI (n = 33), preschool staff not involved in EIBI (n = 26), behaviour modification experts (n = 60), school staff (n = 25) and parents of children with ASD (n = 150) [N = 294]. A 27-item (15 knowledge and 12 allegiance questions) online questionnaire was collected.

    Results: Supervised preschool staff conducting EIBI had more knowledge than preschool staff not using EIBI, but they were not more allegiant. Compared with behaviour modification experts, the supervised EIBI preschool staff group showed markedly less knowledge and allegiance.

    Conclusions: Findings indicate potential for improvement regarding formal knowledge levels of preschool staff delivering EIBI to children with ASD in real-world settings. In addition, fostering EIBI allegiance might be prioritized when teaching EIBI among non-experts. Broadly increased EIBI knowledge levels among all preschool teachers should be achieved by adding behaviour modification techniques to common university curricula in preschool education. Allegiance of preschool personnel might be accomplished by EIBI supervisors meeting skepticism in practice with conveyance of evidence-based principles and discussions of ethical issues.

  • 222.
    Ma, Lichen
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Zetterlund, Elin
    Nöjd, Sofia
    Ek, Anna-Karin
    Åbyhammar, Gustaf
    Kruijt, Anne-Wil
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Furmark, Tomas
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Attentional bias modification in virtual reality2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: It has been theorised that attentional biases (sensitivity and hypervigilance towards threat-related information) may play a causal role in the aetiology and maintenance of dysfunctional anxiety. Attentional bias modification (ABM) aims to directly modify the underlying attentional biases implicated in anxiety disorders, and consequently reduce anxiety symptoms.

    We conducted two studies that examined the effectiveness of ABM training programs in reducing attentional bias and anxiety. Both programs were delivered via virtual reality (VR) technology. Study 1 utilised a traditional dot-probe ABM, and Study 2 utilised a Person Identity Match (PIM) ABM. In addition to the comparison of two different ABM programs, the studies also investigated whether the use of 3 dimensional stimuli has an impact on the outcome of the ABM training.

    Methods:

    Study 1

    One hundred participants with elevated anxiety scores (LSAS > 30) were randomly assigned to 4 groups:

    1. ABM with 2D stimuli (n = 25)2. Mock-ABM with 2D stimuli (n = 25)3. ABM with 3D stimuli (n = 25)4. Mock-ABM with 3D stimuli (n = 25)

    The participants first completed questionnaires that measured their anxiety and other factors of interest. After which the participants completed 100 trials of a dot-probe task to measure their pre-training attentional bias. The participants then completed 360 trials of ABM training. Following ABM, the participants carried out post-training bias measurement and anxiety measurement. Finally, the participants answered follow-up questionnaires 1 week and 3months after the ABM training.

    Study 2

    Study 2 shares the exact same design as Study 1, but utilised a different version of ABMtraining.

    Results: Data analysis is currently ongoing and results are pending. The change in attentional bias and anxiety are the primary outcome measures. Both within-group comparisons (pre-training vs. post-training) and between-group comparisons (ABM vs. mock; 2D vs 3D; Dot-probe vs. PIM) will be carried out. Some preliminary results will be presented at the conference.

    Conclusions: Pending

  • 223. Magalhães, Adsson
    et al.
    Borg, Elisabet
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Perception och psykofysik.
    Mörtberg, Ewa
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Costa, Marcelo
    Improving the psychological assessment of patients by using psychophysical methods2018Inngår i: Fechner Day 2018: Proceedings of the 34th Annual Meeting of the International Society for Psychophysics / [ed] Friedrich Müller, Lara Ludwigs, Malizia Kupper, International Society for Psychophysics , 2018, s. 45-49Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    For many years, psychologists have developed instruments for assessing disorders based on ordinal scales. These scales, despite being widely used, easy to apply, and producing good results, have some imperfections. By bringing the knowledge acquired by the psychophysics field during the last century, it is possible to improve psychological assessment creating new instruments based in psychophysical methods of measurement like ratio scaling.

  • 224. Magnusson, Kristoffer
    et al.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    The Consequences of Ignoring Therapist Effects in Trials With Longitudinal Data: A Simulation Study2018Inngår i: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 86, nr 9, s. 711-725Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Psychotherapy trials frequently generate multilevel longitudinal data with 3 levels. This type of hierarchy exists in all trials in which therapists deliver the treatment and patients are repeatedly measured. Unfortunately, researchers often ignore the possibility that therapists could differ in their performance and instead assume there is no difference between therapists in their average impact on patients' rate of change. In this article, we focus on scenarios in which therapists are fully and partially nested within treatments and investigate the consequences of ignoring even small therapist effects in longitudinal data.

    Method: We first derived the factors leading to increased Type I errors for the Time x Treatment effect in a balanced study. Scenarios with an unbalanced allocation of patients to therapists and studies with missing data were then investigated in a comprehensive simulation study, in which the correct 3-level linear mixed-effects model, which modeled therapist effects using a random slope at the therapist level, was compared with a misspecified 2-level model.

    Results: Type I errors were strongly influenced by several interacting factors. Estimates of the therapist-level random slope suffer from bias when there are very few therapists per treatment.

    Conclusion: Researchers should account for therapist effects in the rate of change in longitudinal studies. To facilitate this, we developed an open source R package powerlmm, which makes it easy to investigate model misspecification and conduct power analysis for these designs.

  • 225. Magnusson, Kristoffer
    et al.
    Nilsson, Anders
    Andersson, Gerhard
    Hellner, Clara
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Internet-Delivered Cognitive-Behavioral Therapy for Significant Others of Treatment-Refusing Problem Gamblers: A Randomized Wait-List Controlled Trial2019Inngår i: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 87, nr 9, s. 802-814Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Problem gambling can cause severe harm to concerned significant others (CSOs) in the form of, for example, relationship problems, financial difficulties, and mental and physical illness. CSOs are important for their ability to support problem gamblers and motivate them to change. This study investigated the effect of an Internet-based intervention for CSOs of treatment-refusing problem gamblers on (a) gambling-related harm, (b) the gamblers' treatment-seeking rate, and (c) the relationship satisfaction and mental health of the CSOs. Method: A total of 100 CSOs of problem gamblers were randomized into one of two conditions: Internet-delivered cognitive-behavioral therapy for CSOs or a wait-list control group. The intervention group was given Internet-based treatment consisting of nine modules with therapist support available via telephone and e-mail. Outcome measures were collected up 12 months posttreatment. Results: The intervention improved the psychological well-being of the CSOs compared to the wait-list group at the posttest (CSO's emotional consequences: d = -0.90, 95% CI [-1.47, -0.33]; relationship satisfaction: d = 0.41, 95% CI [0.05, 0.76]; anxiety: d = -0.45, 95% CI [-0.81, -0.09]; depression: d = -0.49, 95% CI [-0.82, -0.16]). However, the effects on the gambling outcomes were small and inconclusive (gambling losses: multiplicative effect -0.73, 95% CI [0.29, 1.85]; treatment-seeking: hazard ratio = 0.86, 95% CI [0.31, 2.38]). Conclusion: The results confirm earlier studies' findings that affecting the gambler via a CSO is challenging, but it is possible to increase the CSO's coping and well-being. The trial's outcome data and scripts are available for download (https://osf. io/awtg7/).

  • 226. Magnusson, Kristoffer
    et al.
    Nilsson, Anders
    Andersson, Gerhard
    Hellner, Clara
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Level of Agreement Between Problem Gamblers’ and Collaterals’ Reports: A Bayesian Random-Effects Two-Part Model2019Inngår i: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 35, nr 4, s. 1127-1145Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study investigates the level of agreement between problem gamblers and their concerned significant others (CSOs) regarding the amount of money lost when gambling. Reported losses were analyzed from 266 participants (133 dyads) seeking treatment, which included different types of CSO–gambler dyads. The intraclass correlation coefficients (ICCs) concerning the money lost when gambling during the last 30 days were calculated based on the timeline followback. In order to model reports that were highly skewed and included zeros, a two-part generalized linear mixed-effects model was used. The results were compared from models assuming either a Gaussian, two-part gamma, or two-part lognormal response distribution. Overall, the results indicated a fair level of agreement, ICC = .57, 95% CI (.48, .64), between the gamblers and their CSOs. The partner CSOs tended to exhibit better agreement than the parent CSOs with regard to the amount of money lost, ICCdiff = .20, 95% CI (.03, .39). The difference became smaller and inconclusive when reports of no losses (zeros) were included, ICCdiff = .16, 95% CI (− .05, .36). A small simulation investigation indicated that the two-part model worked well under assumptions related to this study, and further, that calculating the ICCs under normal assumptions led to incorrect conclusions regarding the level of agreement for skewed reports (such as gambling losses). For gambling losses, the normal assumption is unlikely to hold and ICCs based on this assumption are likely to be highly unreliable.

  • 227. Magnusson, Kristoffer
    et al.
    Nilsson, Anders
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Modeling Longitudinal Gambling Data: Challenges and Opportunities2019Manuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Clinical studies investigating treatments for problem gambling or gambling disorder frequently use gambling expenditure, such as gambling losses, as a treatment outcome. Gambling losses frequently vary substantially between participants; some report no losses, and some report substantial losses. In this article, we review how gambling losses are commonly analyzed in treatment studies, and show that frequently used methods, such as a log(y+1) transformation or assuming a normal distribution, often perform poorly for these types of data. We propose that a marginalized longitudinal two-part model is a more attractive option. The models are compared using real data from a trial including 136 persons with gambling disorder. Additionally, different performance metrics are further evaluated in a Monte Carlo simulation study. We conclude that gambling researchers should consider using the longitudinal two-part model as it offers a flexible and powerful way of modeling gambling outcomes. The log(y + 1) transformation can be highly misleading in typical gambling data, as a difference in the number of zeros leads to biased estimates of the treatment effects.

  • 228. Magnusson, Kristoffer
    et al.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Boettcher, Johanna
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 285-285Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Objective: Psychological treatments can relieve mental distress and improve well-being, and the dissemination of evidencebased methods is believed to aid patients in gaining access to the right type of help. Meanwhile, Internet-based cognitive behavior therapy (ICBT) has shown promising results for many psychiatric disorders. However, research on the potential for negative effects of psychological treatments has been lacking. Method: An individual patient data meta-analysis of 29 clinical trials of ICBT (N = 2866) was performed using the Reliable Change Index for each of the primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were subsequently conducted using generalized linear mixed models. Missing data was handled by multiple imputation. Results: Deterioration rates were 122 (5.8%) in treatment and 130 (17.4%) in control conditions, yielding a total of 252 (8.8%). Patients in a control condition had higher odds of deteriorating, Odds Ratios (OR) 3.10, 95% Confidence Interval (CI) [2.21-4.34]. Clinical severity at pre treatment was related to lower odds, OR 0.62, 95% CI [0.50-0.77], and 0.51, 95% CI [0.51-0.80], for treatment and control conditions. In terms of sociodemographic variables, being in a relationship, 0.58, 95% CI [0.35-0.95], having at least a university degree, 0.54, 95% CI [0.33-0.88], and being older, 0.78, 95% CI, [0.62-0.98], were also associated with lower odds of deterioration, but only for patients assigned to treatment. Conclusion: Deterioration among patients receiving ICBT is not uncommon and should be monitored by researchers in order to reverse a negative treatment trend.

  • 229. Martin, Katherine Riley
    et al.
    Rothbaum, Barbara
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Botella, Cristina
    Peskin, Melissa
    Loucks, Laura
    Powers, Mark
    Real World Observations Using Virtual Reality Treatments for Anxiety and Related Disorders2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    This session will present recent advances in virtual reality therapy for depression, anxiety, and related disorders. Many of these advances are a result of a boom in personal consumer electronics. We will discuss both stationary (e.g. Virtually Better, Oculus Rift) and mobile (e.g. Samsung Gear) systems along with new stimuli and capture techniques. Together, these advances improve the efficacy and availability of high tech solutions to previous obstacles in the delivery of cognitive behavioral therapy. The first presentation is a randomized controlled trial of therapist and internet administered one-session virtual reality exposure therapy for public speaking anxiety. The second presentation is an Individual Patient Data Meta-Analysis (IPDMA) of 35 virtual reality studies with 846 patients. Outcome data include overall findings and deterioration rates along with moderators. The third presentation will describe the relationship between posttraumatic and depressive symptoms during virtual reality exposure therapy with a cognitive enhancer. The fourth presentation describes a study that examined the feasibility and efficacy of VRE in treating MST-related PTSD. The fifth presentation will discuss a randomized controlled trial of animated versus live action virtual reality therapy for anxiety & pain in a Level I Trauma Center. Finally, the discussant, who has decades of experience in the field of VRET, will cover implications and future directions in the field of VR in the treatment of mental disorders.

  • 230.
    Miloff, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Stockholm Health Care Services, Stockholm County, Sweden.
    Dafgård, Peter
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Deak, Stefan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Garke, Maria
    Hamilton, William
    Heinsoo, Julia
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Kristoffersson, Glenn
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Rafi, Jonas
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Sindemark, Kerstin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Sjölund, Jessica
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Zenger, Maria
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial2019Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 118, s. 130-140Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study compared the efficacy of a technician-assisted single-session virtual reality exposure therapy (VRET) for the treatment of spider phobia featuring low-cost consumer-available hardware and novel automated software to gold-standard in-vivo one-session treatment (OST), using a parallel group randomized non-inferiority design. Method Participants (N = 100) were randomized to VRET and OST arms. Assessors blinded to treatment allocation evaluated participants at pre- and post-treatment as well follow-up (3 and 12 months) using a behavioral approach test (BAT) and self-rated fear of spider, anxiety, depression and quality-of-life scales. A maximum post-treatment difference of 2-points on the BAT qualified as non-inferiority margin. Results Linear mixed models noted large, significant reductions in behavioral avoidance and self-reported fear in both groups at post-treatment, with VRET approaching the strong treatment benefits of OST over time. Non-inferiority was identified at 3- and 12- months follow-up but was significantly worse until 12-months. There was no significant difference on a questionnaire measuring negative effects. Conclusions Automated VRET efficaciously reduced spider phobia symptoms in the short-term and was non-inferior to in-vivo exposure therapy in the long-term. VRET effectiveness trials are warranted to evaluate real-world benefits and non-specific therapeutic factors accruing from the presence of a technician during treatment. ClinicalTrials.gov (NCT02533310).

  • 231.
    Miloff, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Hamilton, W.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Single-session gamified virtual reality exposure therapy for spider phobia vs. traditional exposure therapy: A randomized-controlled trial2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: Traditional one-session therapy (OST) in which a patient is gradually exposed to feared stimuli for up to 3hrs in a one-session format has been found effective for the treatment of specific phobias. However, many suffering from specific phobia are reluctant to seek help and access to care is lacking. Virtual reality (VR) exposure therapy using a smartphone may improve upon existing techniques by facilitating access, lowering cost, and increasing acceptability and effectiveness. The aim of this study was to compare traditional OST with in-vivo spiders and a human therapist to a newly developed single-session gamified VR exposure therapy application with modern VR headsets, virtual spiders and a virtual therapist.

    Method: Participants with specific phobia to spiders (N=100) were recruited from the general public, screened and randomized to either OST (N=50) or VR exposure therapy (N=50) using the smartphone-based Samsung Gear VR system. A behavioral approach test using in-vivo spiders served as the primary outcome measure. Secondary outcome measures included spider phobia questionnaires, and self-reported anxiety, depression and quality of life. Outcomes were assessed 1-week before and after treatment and at follow-up (12 and 52 weeks).

    Results: At the time of submitting this abstract all participants have been included and randomized and a large portion has also received the allotted treatment. However, since the study uses strict blinding, results will not be available until March 2016.

    Discussion: VR exposure therapy has previously been evaluated as a treatment for specific phobias but there has been a lack of high-quality randomized controlled trials. A new generation of modern VR devices are being released which advance upon existing technology and have the potential to improve clinical availability and treatment effectiveness.

    Conclusion: Preliminary clinical observations suggest that single-session gamified virtual reality exposure therapy using a smartphone is effective for the treatment of spider phobia.

  • 232.
    Miloff, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Hamilton, William
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Is virtual reality treatment for spider phobia noninferior to traditional one-session treatment? The results of a randomized-controlled trial2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 753-753Konferansepaper (Annet (populærvitenskap, debatt, mm))
    Abstract [en]

    This is the first large randomized-controlled trial to evaluate whether commercially available VR hardware and software can be used for exposure therapy. The aim of this study is to compare gold-standard One Session Treatment (OST) for reduction of spider phobia symptoms and avoidance behaviour using in vivo spiders and a human therapist, to a newly developed single-session gamified Virtual Reality Exposure Therapy (VRET) application with modern, consumer-available VR hardware, virtual spiders, and a virtual therapist. Subjects (N = 100) with spider phobia, diagnosed, and meeting inclusion criteria were recruited from the general population and randomized to 2 treatment arms. In 1-week intervals, pre-measurement, 3-hr treatment and post-measurement were completed with an in-vivo behavioral approach test (BAT) serving as the primary outcome measure for both groups. This study was powered to detect a non-inferiority margin of a 2-point between-group difference on the BAT, with a standard deviation of 4 (at 80% power). 98 patients commenced treatment and 97 patients completed post-measurement. Per protocol analysis indicated VR was not non-inferior to OST. Repeated-measures ANOVA identified a significant main effect of time (p < .001) and time x group effect (p < .05). Both OST and VR participants experienced large BAT within-group effect sizes (d = 2.28 and d = 1.45, respectively). OST is the superior treatment option for spider phobia. VRET is an effective alternative if OST cannot be provided, as pure self-help, as the initial intervention in a stepped-care model, or as a possible post-OST booster. Future studies will benefit from evaluating effectiveness of VRET when conducted at home.

  • 233.
    Miloff, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Hamilton, William
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Mimerse, Stockholm, Sweden.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Single-session gamified virtual reality exposure therapy for spider phobia vs. traditional exposure therapy: study protocol for a randomized controlled non-inferiority trial2016Inngår i: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 17, artikkel-id 60Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Traditional one-session exposure therapy (OST) in which a patient is gradually exposed to feared stimuli for up to 3 h in a one-session format has been found effective for the treatment of specific phobias. However, many individuals with specific phobia are reluctant to seek help, and access to care is lacking due to logistic challenges of accessing, collecting, storing, and/or maintaining stimuli. Virtual reality (VR) exposure therapy may improve upon existing techniques by facilitating access, decreasing cost, and increasing acceptability and effectiveness. The aim of this study is to compare traditional OST with in vivo spiders and a human therapist with a newly developed single-session gamified VR exposure therapy application with modern VR hardware, virtual spiders, and a virtual therapist. Methods/design: Participants with specific phobia to spiders (N = 100) will be recruited from the general public, screened, and randomized to either VR exposure therapy (n = 50) or traditional OST (n = 50). A behavioral approach test using in vivo spiders will serve as the primary outcome measure. Secondary outcome measures will include spider phobia questionnaires and self-reported anxiety, depression, and quality of life. Outcomes will be assessed using a non-inferiority design at baseline and at 1, 12, and 52 weeks after treatment. Discussion: VR exposure therapy has previously been evaluated as a treatment for specific phobias, but there has been a lack of high-quality randomized controlled trials. A new generation of modern, consumer-ready VR devices is being released that are advancing existing technology and have the potential to improve clinical availability and treatment effectiveness. The VR medium is also particularly suitable for taking advantage of recent phobia treatment research emphasizing engagement and new learning, as opposed to physiological habituation. This study compares a market-ready, gamified VR spider phobia exposure application, delivered using consumer VR hardware, with the current gold standard treatment. Implications are discussed.

  • 234. Minns, Sean
    et al.
    Levihn-Coon, Andrew
    Carl, Emily
    Smits, Jasper A. J.
    Miller, Wayne
    Howard, Don
    Papini, Santiago
    Quiroz, Simon
    Lee-Furman, Eunjung
    Telch, Michael
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Xanthopoulos, Drew
    Powers, Mark B.
    Immersive 3D exposure-based treatment for spider fear: A randomized controlled trial2018Inngår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 58, s. 1-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Stereoscopic 3D gives the viewer the same shape, size, perspective and depth they would experience viewing the real world and could mimic the perceptual threat cues present in real life. This is the first study to investigate whether an immersive stereoscopic 3D video exposure-based treatment would be effective in reducing fear of spiders. Participants with a fear of spiders (N = 77) watched two psychoeducational videos with facts about spiders and phobias. They were then randomized to a treatment condition that watched a single session of a stereoscopic 3D immersive video exposure-based treatment (six 5-min exposures) delivered through a virtual reality headset or a psychoeducation only control condition that watched a 30-min neutral video (2D documentary) presented on a computer monitor. Assessments of spider fear (Fear of Spiders Questionnaire [FSQ], Behavioral Approach Task [BAT], & subjective ratings of fear) were completed pre- and post-treatment. Consistent with prediction, the stereoscopic 3D video condition outperformed the control condition in reducing fear of spiders showing a large between-group effect size on the FSQ (Cohen's d = 0.85) and a medium between group effect size on the BAT (Cohen's d = 0.47). This provides initial support for stereoscopic 3D video in treating phobias.

  • 235. Molander, Olof
    et al.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Stockholm Center for Dependency Disorders, Sweden.
    Bjureberg, Johan
    Ramnerö, Jonas
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Berman, Anne H.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. Karolinska Institutet, Sweden; Stockholm Center for Dependency Disorders, Sweden.
    Internet-based Cognitive Behavior Therapy for Gambling Disorder and Psychiatric Co-morbidities: A Pilot Study Protocol2019Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Context: Although cognitive behavioral therapy (CBT) is recommended to address the high prevalence of co-occurring mental ill health in problem gamblers, there are, to our knowledge, no specific treatment protocols available targeting psychiatric co-morbidities. Furthermore, psychiatric co-morbidities are seldom addressed in gambling treatment studies.

    Intervention: We are currently developing a new internet-based CBT protocol based on the Pathways model [1]. Briefly, this etiological model states that there are distinct pathways for development and maintenance of gambling problem in conjunction with psychiatric co-morbidities. Our treatment will offer tailored behavioral interventions targeting the specific maintenance processes for each gambling pathway proposed by the Pathway model.

    Methods: Treatment-seeking participants (N=20) with Gambling Disorder and psychiatric co-morbidities will be recruited in a first pilot study delivered via the internet. In addition to evaluating feasibility and potential efficacy, we will examine moderators according to the proposed maintenance processes in the Pathways model.

    Results: The pilot study is planned to commence spring 2019.

    Conclusion: The results of the pilot study will hopefully contribute to specific knowledge regarding treatment interventions for gamblers with psychiatric co-morbidities, as well as to the research field as a whole.

  • 236. Månsson, K. N. T.
    et al.
    Salami, A.
    Frick, A.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, G.
    Furmark, T.
    Boraxbekk, C.-J.
    Neuroplasticity in response to cognitive behavior therapy for social anxiety disorder2016Inngår i: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 6, artikkel-id e727Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Patients with anxiety disorders exhibit excessive neural reactivity in the amygdala, which can be normalized by effective treatment like cognitive behavior therapy (CBT). Mechanisms underlying the brain’s adaptation to anxiolytic treatments are likely related both to structural plasticity and functional response alterations, but multimodal neuroimaging studies addressing structure–function interactions are currently missing. Here, we examined treatment-related changes in brain structure (gray matter (GM) volume) and function (blood–oxygen level dependent, BOLD response to self-referential criticism) in 26 participants with social anxiety disorder randomly assigned either to CBT or an attention bias modification control treatment. Also, 26 matched healthy controls were included. Significant time × treatment interactions were found in the amygdala with decreases both in GM volume (family-wise error (FWE) corrected PFWE=0.02) and BOLD responsivity (PFWE=0.01) after successful CBT. Before treatment, amygdala GM volume correlated positively with anticipatory speech anxiety (PFWE=0.04), and CBT-induced reduction of amygdala GM volume (pre–post) correlated positively with reduced anticipatory anxiety after treatment (PFWE0.05). In addition, we observed greater amygdala neural responsivity to self-referential criticism in socially anxious participants, as compared with controls (PFWE=0.029), before but not after CBT. Further analysis indicated that diminished amygdala GM volume mediated the relationship between decreased neural responsivity and reduced social anxiety after treatment (P=0.007). Thus, our results suggest that improvement-related structural plasticity impacts neural responsiveness within the amygdala, which could be essential for achieving anxiety reduction with CBT.

  • 237.
    Månsson, Kristoffer
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Uppsala University, Sweden.
    Cortes, Diana
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Lin, Tian
    Horta, Marilyn
    Frazier, Ian
    Lussier, Desiree
    Feifel, David
    Fischer, Håkan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Ebner, Natalie
    Neuroplasticity after acute and repeated exposure to oxytocin: a multi-site MRI analysis2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Introduction: The hormone and neuropeptide oxytocin (OT) is suggested to be a crucial chemical modulator of social behavior, and exogenous intranasal oxytocin administration has been proposed as a potential treatment for affective and social deficits. Animal studies have found that repeated administration of OT induced cellular changes in the brain, particularly in the hippocampus complex (Sanchez-Vidana et al., 2016). To test this modulatory role of OT on brain structure in humans, we pooled data from three independent double-blind placebo-controlled OT studies that included structural magnetic resonance imaging (MRI), one study with repeated doses over time (repeated) and two studies with single dose (acute) oxytocin administration.

    Methods: The first analytic step included data from 25 older individuals (61-84y) who were exposed to four weeks of intranasal (24 IUs twice a day) administration of OT or placebo (P) and who underwent 3T-MRI before and after this intervention. The second analytic step included data from a total of 191 younger (18-31y) and older (63-81y) individuals from two similar studies administering a single-dose of OT (24 and 40 IUs respectively) and a single 3T-MRI session (scanning was performed about 40 minutes after the OT or P administration). Grey matter (GM) volume was assessed on T1-weighted anatomical images using automated tools (i.e., CAT12/SPM12). We applied total intracranial volume, sex, and education as covariates of no interest and hippocampus voxel-wise analyses were small volume corrected with a family-wise error (FWE) to determine statistical significance. A portion of the analyses were performed blindly, i.e., the researchers were not aware of the assigned group labels (OT vs. P).

    Results: First, a group x time interaction (xyz[–16,–10,–22], Z=4.40, pFWE=.005) suggested that repeated administration of OT in older adults showed no significant change in left hippocampal GM volume (trend toward increase), whereas the P group showed significant reduction in left hippocampal GM volume over time. Second, the acute effect of a single dose of OT showed reduction in left hippocampal GM volume after OT relative to P administration (xyz[–22,–12,–22], Z=2.96, pFWE=.023), i.e. the acute findings were reversed within the same hippocampal region compared to the findings after repeated administration.

    Conclusions: These results provide first evidence of an opposite effect in hippocampus GM volume after acute and repeated administration of OT. This points towards a potential mechanism wherein hippocampal GM volume shows rapid reduction after a single dose, but stable (and potentially greater) GM volume after repeated exposure to OT. Thus, hippocampus may be a key target of OT's modulatory potential on the human brain. Future studies should assess both acute and long-lasting effects of OT administration on brain structures and links to behavior, affect, and quality of life. This approach could advance our understanding of the neurobiological mechanisms of OT as a potential treatment for affective and social deficits.

  • 238.
    Månsson, Kristoffer
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Uppsala University, Sweden.
    Garrett, Douglas
    Lindqvist, Daniel
    Wolkowitz, Owen
    Lavebratt, Catharina
    Fischer, Håkan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Furmark, Tomas
    Brain Signal Variability and Indices of Cellular Protection Predicts Social Anxiety Disorder Treatment Outcome2019Inngår i: Proceedings of the 9th World Congress of Behavioural & Cognitive Therapies: Volume I. Research, Applied Issues / [ed] Thomas Heidenreich, Philip Tata, Tübingen: dgvt-Verlag , 2019, Vol. 1, s. 158-158Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    We are currently lacking clinically useful predictors of treatment response in common psychiatric disorders. Non-invasive and increasingly accessible neuroimaging techniques like functional magnetic resonance imaging (fMRI) could be a useful tool. In contrast to the conventional approach investigating the brain’s average responses, the brain’s signal variability could be a better estimate of the brain’s dynamic operations (Garrett et al., 2010, 2015). In addition, telomere attrition is a hallmark of cellular aging and shorter telomeres have been reported in mood and anxiety disorders. Telomere shortening is counteracted by the enzyme telomerase and cellular protection is also provided by the antioxidant enzyme glutathione peroxidase (GPx). Here, we investigate if baseline BOLD-fMRI signal variability, and indices of cellular protection, predicts social anxiety disorder patient’s response to internet-delivered cognitive behavior therapy. Forty-six patients with social anxiety disorder (SAD) were scanned twice with a 3 Tesla fMRI before initiating CBT. Treatment outcome was assessed the Liebowitz Social Anxiety Scale (self-report). 1) BOLD-fMRI acquisition was performed while passively viewing emotional faces flashing on the screen for 80 seconds. Raw BOLD-fMRI data was implemented in an Independent Component Analysis in order to manually denoise images by carefully remove noise from neural signal. Across time, each voxel’s standard deviation was calculated and used as an index of variability. Multivariate partial least squares regression models were used for second level analysis. 2) Telomerase activity and telomere length were measured in peripheral blood mononuclear cells and GPx activity in plasma. Significant latent level brain scores, and baseline analytes were implemented in linear regressions with LSAS-SR change score as the outcome. Results will be presented and discussed.

  • 239.
    Månsson, Kristoffer
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Garrett, Douglas
    Manzouri, Amirhossain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Wiegert, Steffen
    Furmark, Tomas
    Fischer, Håkan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Affective Brain Signal Variability Separates Social Anxiety Disorder Patients From Healthy Individuals2018Inngår i: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 83, nr 9, s. S249-S250Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: Amygdala hyper-responsiveness to negative socio-affective stimuli have typically been demonstrated in patients with social anxiety disorder (SAD). Relative to conventional methods, there is emerging evidence that brain signal variability could be a better predictor of behavior than mean neural response.

    Methods: We recruited 46 patients with SAD (mean age 31, 63% females) and 40 matched healthy controls (HC) to undergo 3 Tesla functional magnetic resonance imaging (fMRI) at 2 time-points, totaling 172 MRIsessions. Blood-oxygen level-dependent (BOLD-fMRI) was performed while viewing happy and fearful faces in blocks of 80 seconds. BOLD-fMRI data was reviewed by manually classifying signal from noise. Variability was calculated as each voxel’s standard deviation on signal across scanning-time. Multivariate partial least squares (PLS) estimated patterns of variability that separates patient from controls.

    Results: PLS found one significant latent variable with cross-block covariance on 64%, permutated (x 1000) P<0.001, bootstrapped 95% confidence intervals on each condition, demonstrating less signal variability to happy faces in patients, relative to controls. This pattern of response was spatially located in several regions across the whole-brain, with large clusters appearing in bilateral amygdala, medial prefrontal cortex and posterior cingulate cortex/precuneus.

    Conclusions: We found that neural response variability to positive socio-affective stimuli accurately separated patients from controls. It is likely that less signal variability highlights a deficit in effective emotion processing. We add to the growing literature on healthy individuals suggesting that task-specific brain signal variability contains useful information. The brain signal variability approach opens new avenues to evaluate and better understand brain function in common psychopathology.

  • 240.
    Månsson, Kristoffer
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindqvist, Daniel
    Yang, Liu
    Wolkowitz, Owen
    Nilsonne, Gustav
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Isung, Josef
    Svanborg, Cecilia
    Boraxbekk, C-J.
    Fischer, Håkan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Lavebratt, Catharina
    Furmark, Tomas
    Can Psychological Treatment Slow Down Cellular Aging in Social Anxiety Disorder?: An Intervention Study Evaluating Changes in Telomere Length and Telomerase Activity2018Inngår i: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 83, nr 9, s. S351-S352Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: Mental illness, including anxiety disorders, is linked to accelerated cell aging. This is evidenced by shorter leukocyte telomere length. Cells with critically short telomeres may undergo apoptosis. In dividing cells, telomere shortening is counteracted by the telomeraseenzyme. Telomerase is reportedly low following chronic psychological stress. We hypothesized that a psychological treatment may increase telomerase activity, less telomere attritionand greater symptom improvement.

    Methods: Forty-six patients (91% SSRI naïve) with social anxiety disorder(SAD; mean age 31, 63% females) underwent a 9-week waiting period, and 9 weeks of Internet-delivered cognitive behavior therapy(CBT). During treatment, symptoms were assessed weekly using the Liebowitz Social Anxiety Scale (LSAS-SR). Fasting blood samples were collected twice before treatment, and at post-treatment. Genomic DNA was extracted using DNeasy® Blood & Tissue Kit (Qiagene) to assess leukocyte telomere length. Telomerase activity was detected by real-time telomeric repeat amplification protocol (RT-TRAP).

    Results: Patients improved significantly on the LSAS-SR (p<.001; Cohen’s d=1.5). Pre-post changes in telomerase and telomere length correlated positively (Pearson’s r=.31, p=.05). Reduced telomerase activity (<33th percentile) was associated with less improvement and increased activity (>66th percentile) with more improvement on the LSAS-SR (Z=-2.4, p=.02).

    Conclusions: We demonstrate, to our knowledge for the first time, that altered telomerase activity is associated with clinical response to a psychological treatment in a psychiatric population. The observed CBT effect on telomerase in patients with SAD is consistent with results from animal trials and a small previous study of antidepressants in humans. Thus, telomerase activation may play an important role in clinical recovery.

  • 241.
    Månsson, Kristoffer N. T.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Uppsala University, Sweden.
    Cortes, Diana S.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Manzouri, Amir
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Li, Tie-Qiang
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Fischer, Håkan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Viewing Pictures Triggers Rapid Morphological Enlargement in the Human Visual Cortex2019Inngår i: Cerebral Cortex, ISSN 1047-3211, E-ISSN 1460-2199Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Measuring brain morphology with non-invasive structural magnetic resonance imaging is common practice, and can be used to investigate neuroplasticity. Brain morphology changes have been reported over the course of weeks, days, and hours in both animals and humans. If such short-term changes occur even faster, rapid morphological changes while being scanned could have important implications. In a randomized within-subject study on 47 healthy individuals, two high-resolution T1-weighted anatomical images were acquired (á 263 s) per individual. The images were acquired during passive viewing of pictures or a fixation cross. Two common pipelines for analyzing brain images were used: voxel-based morphometry on gray matter (GM) volume and surface-based cortical thickness. We found that the measures of both GM volume and cortical thickness showed increases in the visual cortex while viewing pictures relative to a fixation cross. The increase was distributed across the two hemispheres and significant at a corrected level. Thus, brain morphology enlargements were detected in less than 263 s. Neuroplasticity is a far more dynamic process than previously shown, suggesting that individuals’ current mental state affects indices of brain morphology. This needs to be taken into account in future morphology studies and in everyday clinical practice.

  • 242. Månsson, Kristoffer N. T.
    et al.
    Salami, Alireza
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Umeå University, Sweden.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Boraxbekk, C.-J.
    Andersson, Gerhard
    Furmark, Tomas
    Structural but not functional neuroplasticity one year after effective cognitive behaviour therapy for social anxiety disorder2017Inngår i: Behavioural Brain Research, ISSN 0166-4328, E-ISSN 1872-7549, Vol. 318, s. 45-51Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Effective psychiatric treatments ameliorate excessive anxiety and induce neuroplasticity immediately after the intervention, indicating that emotional components in the human brain are rapidly adapTable Still, the interplay between structural and functional neuroplasticity is poorly understood, and studies of treatment-induced long-term neuroplasticity are rare. Functional and structural magnetic resonance imaging (using 3 T MRI) was performed in 13 subjects with social anxiety disorder on 3 occasions over 1 year. All subjects underwent 9 weeks of Internet-delivered cognitive behaviour therapy in a randomized cross-over design and independent assessors used the Clinically Global Impression-Improvement (CGI-I) scale to determine treatment response. Gray matter (GM) volume, assessed with voxel-based morphometry, and functional blood-oxygen level-dependent (BOLD) responsivity to self-referential criticism were compared between treatment responders and non-responders using 2 × 2 (group × time; pretreatment to follow-up) ANOVA. At 1-year follow-up, 7 (54%) subjects were classified as CGI-I responders. Left amygdala GM volume was more reduced in responders relative to non-responders from pretreatment to 1-year follow-up (Z = 3.67, Family-Wise Error corrected p = 0.02). In contrast to previous short-term effects, altered BOLD activations to self-referential criticism did not separate responder groups at follow-up. The structure and function of the amygdala changes immediately after effective psychological treatment of social anxiety disorder, but only reduced amygdala GM volume, and not functional activity, is associated with a clinical response 1 year after CBT.

  • 243.
    Månsson, Kristoffer
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Wager, Tor D.
    Isacsson, Nils
    Kolbeinsson, Örn
    Andersson, Gerhard
    Fischer, Håkan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Furmark, Tomas
    Brain Before Behavior: Temporal Dynamics in the Treatment of Social Anxiety - Neural Changes Occur Early and Precede Clinical Improvement2018Inngår i: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 83, nr 9, s. S130-S131Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: The brain rapidly responds to affective processing and neural responsivity can separate anxiety disorder patients from healthy individuals. Psychiatric treatment also alters brain responsiveness however, the brain’s temporal dynamics during treatment remain unknown. Here, patients with social anxiety disorder (SAD) were treated with cognitive-behavioral therapy (CBT) and functional magnetic resonance imaging (fMRI) assessments were performed before, during and after intervention.

    Methods: Forty-six SAD patients received a 9-week Internet-delivered CBTand symptoms were assessed weekly using the Liebowitz social anxiety scale (LSAS-SR). MRI was acquired at 4 time-points (2 baselines, mid- and post-treatment). Blood-oxygen level-dependent(BOLD-fMRI) was performed while patients viewed negative facial expressions. BOLD-fMRI data was reviewed manually by classifying signal from noise, all subjects contributing with complete data.

    Results: Patients improved slightly from baseline to mid-treatment (P<.001, Cohen’s d=0.34) on the LSAS-SR, but more so from mid- to post-treatment (P<.001, d=1.46). Whole-brain neural responsivity decreased from baseline to post-treatment (False Discovery Rate, FDR P<.005) in the medial prefrontal cortex, precuneus and amygdala/parahippocampus. However, no changes (FDR P>.05) from mid- to post-treatment were found, suggesting that the early alterations accounted for the effect. Furthermore, early response reductions were positively associated with symptom improvement from pre-post treatment (Pearson’s r=.50, P<.001).

    Conclusions: This is, to our knowledge, the first study assessing early and late psychiatric treatment changes in the brain. Interestingly, altered neural responsivity in limbic and default-mode network regions preceded self-reported alleviation of social anxiety. Understanding the brain’s temporal dynamics and subsequent modification of behavior may be highly important for future clinical neuroimaging research.

  • 244.
    Mörtberg, Ewa
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Jansson Fröjmark, Markus
    Psychometric Evaluation of the Social Phobia Inventory and the Mini-Social Phobia Inventory in a Swedish University Student Sample2019Inngår i: Psychological Reports, ISSN 0033-2941, E-ISSN 1558-691X, Vol. 122, nr 1, s. 323-339Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Social anxiety is common in the general population, as well as among students in higher education. For screening of social anxiety, there is a need for brief scales. In the present study, the psychometric properties were examined in a Swedish version of the Social Phobia Inventory (SPIN) and the Mini-Social Phobia Inventory (Mini-SPIN) in a university student sample (n = 161). In addition to the SPIN and Mini-SPIN, participants completed measures of fear of public speaking, general anxiety, depression, and quality of life. Exploratory factor analyses were used to investigate the underlying dimensions of the SPIN, and reliability, convergent, and divergent validity of SPIN and Mini-SPIN were examined by Cronbach’s alpha and correlation analyses. It was found that a shorter eight-item version of the SPIN was associated with two solid factors (fear and avoidance of social interaction and fear and avoidance of criticism), and acceptable internal consistency, convergent, and divergent validity. In addition, the Mini-SPIN was associated with satisfactory convergent validity, but the reliability was not acceptable. It is concluded that the SPIN-8 is a viable screening tool for social anxiety in a university student population.

  • 245.
    Mörtberg, Ewa
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institute, Sweden.
    Jansson-Fröjmark, Markus
    Pettersson, Axel
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Hennlid-Oredsson, Tove
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Psychometric Properties of the Personal Report of Public Speaking Anxiety (PRPSA) in a Sample of University Students in Sweden2018Inngår i: International Journal of Cognitive Therapy, ISSN 1937-1209, E-ISSN 1937-1217, Vol. 11, nr 4, s. 421-433Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Existing measures for examining fear of public speaking are somewhat limited in content and there is a need for scales that assess a broader area including cognitive, behavioral, and physiological dimensions of the fear. This study examined the psychometric properties of the Personal Report of Public Speaking Anxiety (PRPSA) in a sample of university students (n, 273). Participants completed the PRPSA and measures of depression, social and general anxiety, and quality of life. A reduced version of the PRPSA, the PRPSA-18, was found to demonstrate satisfactory internal consistency as well as discriminant and convergent validity. The PRPSA-18 was associated with two solid factors, “Anticipatory anxiety and physiological symptoms during speech performance,” and “Lack of control during speech performance.” A PRPSA-18 score of 58 was found to discriminate participants with higher and lower fear of public speaking. It is concluded that the shorter and more easily administered PRPSA-18 is a credible option for assessing fear of public speaking among university students.

  • 246.
    Mörtberg, Ewa
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Tillfors, Maria
    Furmark, Tomas
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Factor solutions of the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) in a Swedish population2017Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, nr 4, s. 300-314Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Culturally validated rating scales for social anxiety disorder (SAD) are of significant importance when screening for the disorder, as well as for evaluating treatment efficacy. This study examined construct validity and additional psychometric properties of two commonly used scales, the Social Phobia Scale and the Social Interaction Anxiety Scale, in a clinical SAD population (n = 180) and in a normal population (n = 614) in Sweden. Confirmatory factor analyses of previously reported factor solutions were tested but did not reveal acceptable fit. Exploratory factor analyses (EFA) of the joint structure of the scales in the total population yielded a two-factor model (performance anxiety and social interaction anxiety), whereas EFA in the clinical sample revealed a three-factor solution, a social interaction anxiety factor and two performance anxiety factors. The SPS and SIAS showed good to excellent internal consistency, and discriminated well between patients with SAD and a normal population sample. Both scales showed good convergent validity with an established measure of SAD, whereas the discriminant validity of symptoms of social anxiety and depression could not be confirmed. The optimal cut-off score for SPS and SIAS were 18 and 22 points, respectively. It is concluded that the factor structure and the additional psychometric properties of SPS and SIAS support the use of the scales for assessment in a Swedish population.

  • 247. Nilsson, Anders
    et al.
    Magnusson, Kristoffer
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Hellner Gumpert, Clara
    Effects of added involvement from concerned significant others in internet-delivered CBT treatments for problem gambling: Study protocol for a randomised controlled trial2016Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 9, artikkel-id e011974Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Problem gambling is a public health concern affecting ∼2.3% of the Swedish population. Problem gambling also severely affects concerned significant others (CSOs). Several studies have investigated the effect of individual treatments based on cognitive–behavioural therapy (CBT), but less is known of the effect of involving CSOs in treatment. This study aims to compare an intervention based on behavioural couples therapy (BCT), involving a CSO, with an individual CBT treatment to determine their relative efficacy. BCT has shown promising results in working with substance abuse, but this is the first time it is used as an intervention for problem gambling. Both interventions will be internet-delivered, and participants will receive written support and telephone support.

    Methods and analysis: A sample of 120 couples will be randomised to either the BCT condition, involving the gambler and the CSO, or the CBT condition, involving the gambler alone. Measures will be conducted weekly and at 3, 6 and 12 months follow-up. The primary outcome measure is gambling behaviour, as measured by Timeline Followback for Gambling. This article describes the outline of the research methods, interventions and outcome measures used to evaluate gambling behaviour, mechanisms of change and relationship satisfaction. This study will be the first study on BCT for problem gambling.

    Ethics and dissemination: This study has been given ethical approval from the regional ethics board of Stockholm, Sweden. It will add to the body of knowledge as to how to treat problem gambling and how to involve CSOs in treatment. The findings of this study will be published in peer-reviewed journals and published at international and national conferences.

  • 248. Nilsson, Anders
    et al.
    Magnusson, Kristoffer
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Hellner Gumpert, Clara
    The Development of an Internet-Based Treatment for Problem Gamblers and Concerned Significant Others: A Pilot Randomized Controlled Trial2018Inngår i: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 34, nr 2, s. 539-559Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Problem gambling creates significant harm for the gambler and for concerned significant others (CSOs). While several studies have investigated the effects of individual cognitive behavioral therapy (CBT) for problem gambling, less is known about the effects of involving CSOs in treatment. Behavioral couples therapy (BCT) has shown promising results when working with substance use disorders by involving both the user and a CSO. This pilot study investigated BCT for problem gambling, as well as the feasibility of performing a larger scale randomized controlled trial. 36 participants, 18 gamblers and 18 CSOs, were randomized to either BCT or individual CBT for the gambler. Both interventions were Internet-delivered self-help interventions with therapist support. Both groups of gamblers improved on all outcome measures, but there were no differences between the groups. The CSOs in the BCT group lowered their scores on anxiety and depression more than the CSOs of those randomized to the individual CBT group did. The implications of the results and the feasibility of the trial are discussed.

  • 249. Nordahl, Håkon
    et al.
    Havnen, Audun
    Hansen, Bjarne
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Haukeland University Hospital, Norway.
    Kvale, Gerd
    Sleep disturbances in treatment-seeking OCD-patients: Changes after concentrated exposure treatment2018Inngår i: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 59, nr 2, s. 186-191Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Research indicates that patients with Obsessive Compulsive Disorder (OCD) frequently suffer from comorbid sleep difficulties, and that these difficulties often are not clinically recognized and diagnosed. There has been limited research investigating if comorbid sleep difficulties impair treatment outcome for OCD and if the sleep difficulties change following OCD-treatment. Thirty-six patients with obsessive compulsive disorder underwent concentrated exposure treatment delivered in a group over four consecutive days and were assessed with measures of OCD, depressive symptoms and sleep disturbance at three different time points (pre, post and 6 months follow-up). The sample was characterized by a high degree of comorbidity with other psychiatric disorders. At pre-treatment nearly 70% of the patients reported sleep difficulties indicative of primary insomnia. The results showed that patients had large reductions of OCD-symptoms as well as significant improvements in sleep disturbance assessed after treatment, and that these improvements were maintained at follow-up. Sleep disturbance did not impair treatment outcome, on the contrary patients with higher degree of sleep disturbance at pre-treatment had better outcome on OCD-symptoms after treatment. The results indicated that the majority of the OCD sample suffered from sleep disturbances and that these sleep disturbances were significantly reduced following adequate treatment of OCD without specific sleep interventions. However, a proportion of the patients suffered from residual symptoms of insomnia after treatment.

  • 250. Nordgreen, T.
    et al.
    Haug, T.
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Kvale, G.
    Heiervang, E.
    Havik, O.
    Stepped care for social anxiety disorder or panic disorder: A randomised controlled trial2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: Stepped Care is considered a cost-effective way to deliver health care but few studies have investigated stepped care models for psychological treatments. Internet-based psychological treatment might be a highly suitable first step in a stepped care model. The aim of this study was to assess the effectiveness of a cognitive behavioral therapy (CBT) stepped care model (psychoeducation, guided Internet-based treatment, and face-to-face CBT) compared with direct face-to-face (FtF) CBT.

    Methods: Patients with panic disorder or social anxiety disorder were randomized to either stepped care (n = 85) or direct FtF CBT (n = 88). Recovery was defined as meeting two of the following three criteria: loss of diagnosis, below cut-off for self-reported symptoms, and functional improvement.

    Results: No significant differences in intention-to-treat recovery rates were identified between stepped care (40.0%) and direct FtF CBT (43.2%). The majority of the patients who recovered in the stepped care did so at the less therapist-demanding steps (26/34, 76.5%). Moderate to large within-groups effect sizes were identified at posttreatment and 1-year follow-up. The attrition rates were high: 41.2% in the stepped care condition and 27.3% in the direct FtF CBT condition.

    Discussion: These findings indicate that the outcome of a stepped care model for anxiety disorders is comparable to that of direct FtF CBT. The rates of improvement at the two less therapist- demanding steps indicate that stepped care models might be useful for increasing patients’ access to evidence-based psychological treatments for anxiety disorders. However, attrition in the stepped care condition was high. This may reflect inflexible stepping-up criteria. Limitations of this study will be discussed together with suggestions for more relevant and flexible stepping up criteria.

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